Region of Waterloo Form

Required fields are marked with asterisks (*)

Animal Bite/Contact Report

Please provide as much information as possible.

Person Bitten/Scratched

Type of Exposure

Animal Information

Type of Animal

Animal Owner Information

For Hospitals

Wound Care Provided
Rabies Immune Globulin Issued
Rabies Vaccine Issued

NOTE: Collection of information on this form is authorized under the Health Protection and Promotion Act RSO, 1990 CH 7, SECTIONS 5 and 31 for the purpose of controlling and reporting communicable diseases.

For more information, please contact our Health Protection and Investigation program at 519-575-4400.

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